clock drawing test

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Introduction

Draw the face of a clock showing 10 minutes after 11.

Indications

Contraindications

Procedure

Administration:

  • provide the subject with a pencil & blank piece of paper
  • instruct the subject: 'First, draw a clock with all the numbers on it. Second, put the hands on the clock to show 11:10'

Interpretation

Scoring:

  • scoring ranges from 1-10 (10 being best)
  • score of 6-10: drawing of clock face with circle & numbers is generally intact
  • score of 1-5: drawing of clock face with circle & numbers is NOT intact

Score:

  • either no attempt of an uninterpretable effort is made
  • drawing reveals some evidence of instructions being received, but only a vague representation of a clock
  • numbers & clock face are not obviously connected in the drawing; hands are not present
  • distortion of number sequence; integrity of clock face is absent; numbers are missing or placed outside boundary of clock
  • crowding of numbers at on end of the clock or reversal of numbers; hands may be present in some fashion
  • inappropriate drawing of clock hands (use of digital display or circling of numbers, despite repeated instructions)
  • placement of hands is significantly off course
  • significant errors in placement of hour & minute hands
  • slight error in placement of hour &/or minute hands
  • correct drawing of clock; hands in correct position & of appropriate length

As a single instrument, the clock-drawing test provides limited discrimination of lewy body dementia from Alzheimer's disease & Parkinson's disease with Parkinson's dementia.[3]

70% overall accuracy in discriminating Alzheimer's disease from Lewy body dementia & Parkinson's dementia from lewy body dementia. Patients with lewy body dementia were more likely to make conceptual errors than patients with Alzheimer's disease or Parkinson's disease. Patients with Parkinson's dementia & lewy body dementia are more likely to make planning errors than patients' with Alzheimer's disease.

More general terms

Additional terms

References

  1. Sunderland T, Hill JL, Mellow AM, Lawlor BA, Gundersheimer J, Newhouse PA, Grafman JH. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc. 1989 Aug;37(8):725-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/2754157
  2. Wolf-Klein GP, Silverstone FA, Levy AP, Brod MS. Screening for Alzheimer's disease by clock drawing. J Am Geriatr Soc. 1989 Aug;37(8):730-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/2754158
  3. 3.0 3.1 Cahn-Weiner DA, Williams K, Grace J, Tremont G, Westervelt H, Stern RA. Discrimination of dementia with lewy bodies from Alzheimer disease and Parkinson disease using the clock drawing test. Cogn Behav Neurol. 2003 Jun;16(2):85-92. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12799594
  4. 4.0 4.1 Adamis D, Morrison C, Treloar A, Macdonald AJ, Martin FC. The performance of the Clock Drawing Test in elderly medical inpatients: does it have utility in the identification of delirium? J Geriatr Psychiatry Neurol. 2005 Sep;18(3):129-33. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16100101
  5. Scanlan JM, Brush M, Quijano C, Borson S. Comparing clock tests for dementia screening: naive judgments vs formal systems--what is optimal? Int J Geriatr Psychiatry. 2002 Jan;17(1):14-21. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11802225
  6. Borson S, Brush M, Gil E, Scanlan J, Vitaliano P, Chen J, Cashman J, Sta Maria MM, Barnhart R, Roques J. The Clock Drawing Test: utility for dementia detection in multiethnic elders. J Gerontol A Biol Sci Med Sci. 1999 Nov;54(11):M534-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10619314